2003 ishlt j heart lung transplant 2003; 22: 610-72. heart transplantation overall

2003ISHLTJ Heart Lung Transplant 2003; 22: 610-72.

HEART TRANSPLANTATION

Overall


NUMBER OF HEART TRANSPLANTS REPORTED BY YEAR

189 318669

1189

2167

27203157

3378

4016 4186 4199 4346 4402 43144128 4039

37443419 3246 3122

0

500

1000

1500

2000

2500

3000

3500

4000

45001

98

2

19

83

19

84

19

85

19

86

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

Nu

mb

er o

f T

ran

spla

nts


NUMBER OF HEART TRANSPLANTS REPORTED BY YEAR AND LOCATION

0

500

1000

1500

2000

2500

3000

3500

4000

45001

98

2

19

83

19

84

19

85

19

86

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

Nu

mb

er o

f T

ran

spla

nts

South America

North America

Europe

Australia/Oceania

Asia

Africa


AVERAGE CENTER VOLUMEHeart Transplants: January 1, 1998 - June 30, 2002

6049

79

29

136 5 30

10

20

30

40

50

60

70

80

1-4 5-9 10-19 20-29 30-39 40-49 50-74 75+

Average number of heart transplants per year

Nu

mb

er o

f ce

nte

rs


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%1

98

2

19

84

19

86

19

88

19

90

19

92

19

94

19

96

19

98

20

00

% o

f T

ran

sp

lan

ts

0-10 11-17 18-35 36-49 50-59 60+

0

5

10

15

20

25

30

35

Me

an

do

no

r a

ge

(y

ea

rs)

Mean Age

HEART TRANSPLANTS: Donor Age by Year of Transplant


AGE DISTRIBUTIONOF HEART RECIPIENTS (1/1982-6/2002)

% o

f T

r%

of

Tra

ns

pla

nts

ns

pla

nts

0

10

20

30

40

50

60

<1 1-5 6-10 11-17 18-34 35-49 50-64 65+

Recipient Age


AGE DISTRIBUTION OF HEART TRANSPLANT RECIPIENTS BY ERA

0

10

20

30

40

50

60

<11-

56-

10

11-1

7

18-3

4

35-4

9

50-6

465

+ <11-

56-

10

11-1

7

18-3

4

35-4

9

50-6

465

+

% o

f tr

an

sp

lan

ts

p < 0.0001

1985-1996 1/1997-6/2002


HEART TRANSPLANTATION Actuarial Survival (1/1982-6/2001)

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Years

Sur

viva

l (%

)

N=59,391

Half-life = 9.3 yearsConditional Half-life = 12.0 years


HEART TRANSPLANTATION

Adult Recipients


Congenital2%

ReTX2%

Myopathy45%

Misc.1%

Valvular4%

CAD46%

DIAGNOSIS IN ADULT HEART TRANSPLANTS

20

3040

5060

70

1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

% o

f Cas

es

Myopathy CAD


ADULT HEART TRANSPLANTATION Actuarial Survival by Era (Transplants: 1/1982-6/2001)

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Years

1982-1987 (N=6,367)

1988-1992 (N=16,621)

1993-1997 (N=18,743)

1/1998-6/2001 (N=10,678)

All comparisons significant at p < 0.03 except for 1993-1997 vs. 1998-6/2001.

HALF-LIFE 1982-1987: 7.7 years; 1988-1992: 9.3 years; 1993-1997: 9.1 years

Su

rviv

al (

%)


ADULT HEART TRANSPLANTATION Actuarial Survival by Age Group (Transplants: 1/1982-6/2001)

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al

(%)

18-34 (N=5,492) 35-49 (N=15,478)50-64 (N=28,681) 65-69 (N=2,294)70+ (N = 220)

HALF-LIFE 18-34: 11.1 years; 35-49: 9.9 years; 50-64: 8.7 years; 65-69: 7.9 years; 70+: 5.8 years

All pair-wise comparisons are statistically significant at p < 0.001 except: 18-34 vs. 35-49 and 65-69 vs. 70+


ADULT HEART TRANSPLANTATION Actuarial Survival by Diagnosis (Transplants: 1/1982-6/2001)

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8 9 10

Years

Su

rviv

al

(%)

Coronary Artery Disease (N=23,682) Cardiomyopathy (N=25,543)Congenital Diagnosis (N=2,933) Retransplant (N=1,227)Valvular (N=1,917) Other (N=962)

All pair-wise comparisons with Retransplant and Cardiomyopathy are statistically significant at p < 0.05 except Cardiomyopathy vs. Other

HALF-LIFE Cardiomyopathy: 10.3 years; CAD: 8.6 years; Congenital: 12.2 years; Retransplant: 4.2 years; Valvular: 9.7 years; Other: 10.9 years



Age = 18-34 Years

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8

Years

Su

rviv

al (

%)

Coronary Artery Disease (N=146) Cardiomyopathy (N=1,600)

Congenital Diagnosis (N=246) Retransplant (N=88)

Valvular (N=64) Other (N=54)



Age = 35-49 Years

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8

Years

Su

rviv

al (

%)

Coronary Artery Disease (N=2,130) Cardiomyopathy (N=3,484)





Age = 50-64 Years

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8

Years

Su

rviv

al (

%)

Coronary Artery Disease (N=8,057) Cardiomyopathy (N=5,701)





Age = 65-69 Years

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8

Years

Su

rviv

al (

%)

Coronary Artery Disease (N=1,036) Cardiomyopathy (N=560)Retransplant (N=23) Valvular (N=41)



Age = 70+ Years

0

20

40

60

80

100

0 1 2 3 4 5 6 7 8

Years

Su

rviv

al (

%)

Coronary Artery Disease (N=121) Cardiomyopathy (N=53)


ADULT HEART TRANSPLANTATION Actuarial Survival by PVR (Transplants: 4/1994-6/2001)

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8

Years

Su

rviv

al (

%)

1-3 (N=7,386) 3-5 (N=2,651) 5 (N=1,037)

1-3 vs. 3-5: p = 0.0021-3 vs. 5+: p = 0.0063-5 vs. 5+: p = 0.6


ADULT HEART TRANSPLANTATION Actuarial Survival by PVR (Transplants: 4/1994-6/2001)

During first 6 months following transplantation

50

60

70

80

90

100

0.0 0.1 0.2 0.3 0.4 0.5

Years

Su

rviv

al (

%)

1-<3 (N=7,386) 3-<5 (N=2,651) 5+ (N=1,037)

1-<3 vs 3-<5: p = 0.0021-<3 vs. 5+: p = 0.0063-<5 vs. 5+: p = 0.6


0

20

40

60

80

100

0-2 months >2-6 months >6-12months

>12-36months

>36-60months

>60 months

Time between previous and current transplant

1 Y

ear

Pat

ien

t S

urv

ival

(%

) 1/1982-12/1990

1/1991-6/2001

Comparison of survival for interval < 12 months vs. > 12 months: p < 0.0001

ADULT HEART RE-TRANSPLANTS1-Year Survival

123

172

32 18

29

31

64 98

3591

22 286


ADULT HEART TRANSPLANTS (1/1995-6/2001) Risk Factors for 1 Year Mortality

1995-1998 (N=12,353)

1999-6/2001 (N=5,923)

Factor Odds Ratio

p-value Odds Ratio

p-value

Diagnosis: Coronary artery disease 1.25 <.0001 1.00 0.9

Diagnosis: Congenital heart disease 1.74 0.003 2.42 0.0004

Diagnosis: Other (excluding Cardiomyopathy)

1.33 0.003 1.37 0.04

Repeat transplant 1.67 0.0005 0.98 0.9

In hospital (including ICU) 1.7 <.0001 2.51 <.0001



1995-1998 (N=12,353)

1999-6/2001 (N=5,923)

Factor Odds Ratio

p-value

Odds Ratio

p-value

Ventilator 1.97 <.0001 2.53 <.0001

Intra-aortic balloon pump 1.47 0.001 1.09 0.6

IV inotropes 0.6 <.0001 0.54 <.0001

Infection requiring IV drug therapy within 2 weeks of transplant

1.25 0.04 0.97 0.8

PRA > 10% 1.25 0.03 1.26 0.1



1995-1998 (N=12,353)

1999-6/2001 (N=5,923)

Factor Odds Ratio

p-value Odds Ratio

p-value

History of malignancy 1.27 0.1 0.61 0.04

Dialysis 1.90 0.0008 2.58 <.0001

Sternotomy 0.86 0.02 0.91 0.3

0-4 HLA Mismatches 0.93 0.2 0.98 0.8

Male recipient/female donor 1.13 0.04 1.11 0.3

Donor COD: Stroke 1.07 0.2 1.21 0.04



Continuous Factors (see figures) Recipient age

Recipient height

Donor age

Donor weight

Ischemia time

Transplant center volume

Cardiac output

PVR

PA diastolic pressure

Bilirubin

Serum creatinine



Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

Od

ds

of

1 Y

ear

Mo

rtal

ity

1995-1998

1999-6/2001

p = 0.02p < 0.0001



Donor Age

0

0.5

1

1.5

2

10 15 20 25 30 35 40 45 50 55 60

Donor Age

Od

ds

of

1 Y

ear

Mo

rtal

ity

1995-1998

1999-6/2001

p < 0.0001p < 0.0001



Donor Weight

0

0.5

1

1.5

2

40 50 60 70 80 90 100 110

Donor Weight (kg)

Od

ds

of

1 Y

ear

Mo

rtal

ity

1995-1998

1999-6/2001

p = 0.0064p = 0.05



Recipient Height

0

0.5

1

1.5

2

140 150 160 170 180 190

Recipient Height (cm)

Od

ds

of

1 Y

ear

Mo

rtal

ity

1995-1998

1999-6/2001

p < 0.0001p = 0.04



Center volume

0

0.5

1

1.5

2

0 10 20 30 40 50 60 70

Center Volume (cases per year)

Od

ds

of

1 Y

ea

r M

ort

alit

y

1995-1998

1999-6/2001

p = 0.003p < 0.0001



Ischemia time

0

0.5

1

1.5

2

2.5

3

0 1 2 3 4 5 6

Ischemia time (hours)

Od

ds

of

1 Y

ear

Mo

rtal

ity

1995-1998

1999-6/2001

p < 0.0001p < 0.0001



Bilirubin

0

0.5

1

1.5

2

2.5

0 2 4 6 8 10 12 14 16 18 20

Bilirubin (mg/dl)

Od

ds

of

1 Y

ear

Mo

rtal

ity

1995-1998

1999-6/2001

p < 0.0001p < 0.0001



Recipient creatinine

0

1

2

3

4

0 0.5 1 1.5 2 2.5 3 3.5 4

Creatinine (mg/dl)

Od

ds

of

1 Y

ear

Mo

rtal

ity

1995-1998

1999-6/2001

p < 0.0001p < 0.0001



Cardiac Output

0

0.5

1

1.5

2

0 1 2 3 4 5 6 7 8 9 10

Cardiac output (L/min)

Od

ds

of

1 Y

ear

Mo

rtal

ity

1995-1998

1/1999-6/2001

p = 0.03p = 0.06



PVR

0

0.5

1

1.5

2

1 2 3 4 5 6 7 8 9 10

PVR (Wood units)

Od

ds

of

1 Y

ear

Mo

rtal

ity 1995-1998

1/1999-6/2001

p = 0.2p = 0.003



PA Diastolic

0

0.5

1

1.5

2

0 5 10 15 20 25 30 35 40

PA Diastolic (mm Hg)

Od

ds

of

1 Y

ear

Mo

rtal

ity 1995-1998

1/1999-6/2001

p=0.001p=0.09


ADULT HEART TRANSPLANTS (1/1995-6/2001) Factors Not Significant for 1 Year Mortality

Recipient Factors:VAD, ABO identical/compatible, symptomatic cerebrovascular disease/cerebrovascular event, pneumothorax, pregnancy, pulmonary embolism, PA systolic, PCW, history of malignancy, weight



Donor Factors:Gender, clinical infection, history of cancer, history of hypertension, history of diabetes, height

Transplant Factors:Donor/recipient BMI ratio, donor/recipient height ratio, CMV mismatch


ADULT HEART TRANSPLANTS (1995-6/1997) Risk Factors for 5 Year Mortality

VARIABLE Odds Ratio P-value

95% Confidence

Interval

Diagnosis: Coronary artery disease 1.28 <.0001 1.15 - 1.43

Repeat transplant 1.71 0.001 1.24 - 2.36

Infection requiring IV drug therapy within 2 weeks of transplant

1.46 0.001 1.16 - 1.82

Dialysis 2.31 0.0005 1.44 - 3.70

Prior sternotomy 0.85 0.02 0.74 - 0.97

(N=8,271)




Recipient height

Donor age

Donor BMI

Ischemia time


Bilirubin

Serum creatinine

Most recent PRA

Wedge pressure



Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

Od

ds

of

5 Y

ear

Mo

rtal

ity

p = 0.002



Donor Age

0

0.5

1

1.5

2

10 15 20 25 30 35 40 45 50 55 60

Donor Age

Od

ds

of

5 Y

ear

Mo

rtal

ity

p < 0.0001



Donor BMI

0

0.5

1

1.5

2

17 21 25 29 33

Donor BMI (kg/m2)

Od

ds

of

5 Y

ear

Mo

rtal

ity

p = 0.05



Recipient Height

0

0.5

1

1.5

2

140 150 160 170 180 190

Recipient Height (cm)

Od

ds

of

5 Y

ear

Mo

rtal

ity

p < 0.0001



Most Recent PRA

0

0.5

1

1.5

2

0 10 20 30 40 50 60 70 80 90 100

Most recent PRA

Od

ds

of

5 Y

ear

Mo

rtal

ity

p < 0.0001



Center volume

0

0.5

1

1.5

2

0 10 20 30 40 50 60 70


Od

ds

of

5 Y

ea

r M

ort

alit

y

p = 0.007



Ischemia time

0

0.5

1

1.5

2

2.5

0 1 2 3 4 5 6

Ischemia time (hours)

Od

ds

of

5 Y

ear

Mo

rtal

ity

p < 0.0001



Bilirubin

0

1

2

3

4

0 2 4 6 8 10 12 14 16 18 20

Bilirubin (mg/dl)

Od

ds

of

5 Y

ear

Mo

rtal

ity

p = 0.003




0

1

2

3

0 0.5 1 1.5 2 2.5 3 3.5 4

Creatinine (mg/dl)

Od

ds

of

5 Y

ear

Mo

rtal

ity

p < 0.0001



PCW

0

0.5

1

1.5

2

0 5 10 15 20 25 30 35 40

PCW (mm Hg)

Od

ds

of

5 Y

ear

Mo

rtal

ity

p = 0.0009



Recipient Factors:VAD, ventilator, in hospital, IV inotropes, balloon, ABO identical/compatible, symptomatic cerebrovascular disease/cerebrovascular event, pneumothorax, pregnancy, pulmonary embolism, PA systolic, PA diastolic, PVR, history of malignancy, weight, gender, history of malignancy



Donor Factors:Gender, cause of death, clinical infection, history of cancer, history of hypertension, history of diabetes

Transplant Factors:Donor/recipient BMI ratio, donor/recipient height ratio, CMV mismatch, HLA mismatch


ADULT HEART TRANSPLANTS (1995-6/1997) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year


95% Confidence Interval

Diagnosis: Coronary Artery Disease 1.25 0.005 1.07 -1.46

Treated for infection prior to transplant discharge 1.31 0.009 1.07 -1.60

Treated for infection during 1st year 1.28 0.002 1.10 -1.50

CAV during 1st year 1.80 <.0001 1.35 -2.41

Cerebrovascular disease at transplant 1.55 0.01 1.10 -2.20

Insulin dependent diabetes 1.40 0.04 1.01 -1.94

(N=6,273)


ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year MortalityConditional on Survival to 1 Year

Continuous Factors (see figures)

Recipient age

Donor age

Donor BMI

Serum creatinine


ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for 5 Year Mortality Conditional on Survival to 1 Year

Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

Od

ds

of

5 Y

ear

Mo

rtal

ity

p < 0.0001



Donor Age

0

0.5

1

1.5

2

10 15 20 25 30 35 40 45 50 55 60

Donor Age

Od

ds

of

5 Y

ear

Mo

rtal

ity

p = 0.001



Donor BMI

0

0.5

1

1.5

2

17 21 25 29 33

Donor BMI (kg/m2)

Od

ds

of

5 Y

ear

Mo

rtal

ity

p = 0.005




0

0.5

1

1.5

0 0.5 1 1.5 2 2.5 3 3.5 4

Creatinine (mg/dl)

Od

ds

of

5 Y

ear

Mo

rtal

ity

p = 0.03



Conditional on Survival to 1 Year

Recipient Factors:VAD, ventilator, in hospital, IV inotropes, balloon, ABO identical/compatible, symptomatic cerebrovascular disease/cerebrovascular event, pneumothorax, pregnancy, pulmonary embolism, PA systolic, PA diastolic, PCW, PVR, history of malignancy, height, weight, gender, history of malignancy, PRA, bilirubin


ADULT HEART TRANSPLANTS (1/1995-6/1997) Factors Not Significant for 5 Year Mortality Conditional on

Survival to 1 Year

Donor Factors:Gender, cause of death, clinical infection, history of cancer, history of hypertension, history of diabetes

Transplant Factors:Donor/recipient BMI ratio, donor/recipient height ratio, CMV mismatch, HLA mismatch, center volume, ischemia time

Post-transplant Factors:Dialysis, prolonged graft dysfunction, permanent pacemaker


ADULT HEART RECIPIENTS Functional Status (Follow-ups: April 1994-June 2002)

0%

20%

40%

60%

80%

100%

1 Year (N = 12,811) 3 Years (N = 11,249) 5 Years (N = 9,532)

No Activity Limitations Performs with Some Assistance Requires Total Assistance


ADULT HEART RECIPIENTSEmployment Status (Follow-ups: April 1994-June 2002)

0%

20%

40%

60%

80%

100%

1 Year (N = 12,023) 3 Years (N = 10,396) 5 Years (N = 8,716)

Retired

Not Working

Working Part Time

Working Full Time


ADULT HEART RECIPIENTSRehospitalization Post-transplant (Follow-ups: April 1994 - June 2002)

0%

20%

40%

60%

80%

100%

Up to 1 Year (N = 13,930) Between 2 and 3 Years (N = 11,880)

Between 4 and 5 Years (N = 10,052)

No Hospitalization Hospitalized: Not Rejection/Not InfectionHospitalized: Rejection Only Hospitalized: Infection OnlyHospitalized: Rejection + Infection


0

10

20

30

40

50

Any Induction (N =2,441)

PolyclonalALG/ATG (N =

1,220)

OKT3 (N = 617) IL2R-antagonist (N= 904)

% o

f p

ati

en

ts

ADULT HEART RECIPIENTSInduction Immunosuppression (Follow-ups: January 2000 – June 2002)


0

10

20

30

40

50

Any Induction (N = 1,036)

Polyclonal ALG/ATG (N = 581)

OKT3 (N = 382)

IL2R-antagonist (N = 321)

Any Induction (N = 987)


OKT3 (N = 176)


Any Induction (N = 418)


OKT3 (N = 59)


% o

f p

ati

en

ts 2000 2001 2002(6 months)

ADULT HEART RECIPIENTSInduction Immunosuppression (Follow-ups: January 2000 - June 2002)


0

20

40

60

80

100

Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone

% o

f P

ati

en

ts

Year 1 (N = 3,916) Year 5 (N = 3,364)

ADULT HEART RECIPIENTS Maintenance Immunosuppression at Any Time During Follow-up Period

For follow-ups between January 2000 through June 2002

NOTE: Different patients are analyzed in Year 1 and Year 5


0

20

40

60

80

100

Cyclosporine Tacrolimus Rapamycin MMF Azathioprine Prednisone

% o

f P

ati

en

ts

Year 1 (N = 3,793) Year 5 (N = 3,103)

ADULT HEART RECIPIENTS Maintenance Immunosuppression at Time of Follow-up




0%

20%

40%

60%

80%

100%

Year 1 (N = 3,793) Year 5 (N = 3,103)

% o

f P

ati

en

ts

Other

Tacrolimus + MMF

Tacrolimus + AZA

Cyclosporine + MMF

Cyclosporine + AZA

ADULT HEART RECIPIENTS Maintenance Immunosuppression Drug Combinations at Time of Follow-up




POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 1 Year Post-Transplant

(Follow-ups: April 1994-June 2002)

Outcome Within 1 Year

Hypertension 72.8% (N = 13,507)

Renal Dysfunction 25.6% (N = 16,533)

Abnormal Creatinine < 2.5 mg/dl 15.3% Creatinine > 2.5 mg/dl 8.9% Chronic Dialysis 1.3% Renal Transplant 0.2%

Hyperlipidemia

50.3% (N = 14,245)

Diabetes 24.4% (N = 13,479)

CAV 8.1% (N = 12,174)


POST-HEART TRANSPLANT MORBIDITY FOR ADULTS Cumulative Prevalence in Survivors within 5 Years Post-Transplant

(Follow-ups: April 1994-June 2002)

Outcome Within 5 Years

Hypertension 94.6% (N = 4,042)

Renal Dysfunction 31.0% (N = 4,579)

Abnormal Creatinine < 2.5 mg/dl 18.5% Creatinine > 2.5 mg/dl 9.8% Chronic Dialysis 2.4% Renal Transplant 0.4%

Hyperlipidemia

82.4% (N = 4,539)

Diabetes 32.3% (N = 4,012)

CAV 32.5% (N = 2,797)


Freedom from CAV and Freedom from Severe Renal Dysfunction*

For Adult Heart Recipients (Follow-ups: April 1994-June 2002)

0

10

20

30

40

50

60

70

80

90

100

0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5

Years

% F

ree

fro

m C

AV

or

Fre

ed

om

fro

m S

ev

ere

Re

na

l D

ys

fun

cti

on

Freedom from CAV

Freedom from Severe Renal Dysfunction

* Severe renal dysfunction = Creatinine > 2.5 mg/dl, dialysis or renal transplant


MALIGNANCY POST-HEART TRANSPLANTATION FOR ADULTSCumulative Prevalence in Survivors (Follow-ups: April 1994-June 2002)

Malignancy/Type 1-Year Survivors 5-Year Survivors

No Malignancy 13699 (96.7%) 3728 (82.0%)

Malignancy (all types combined) 470 (3.3%) 821 (18.0%)

Malignancy Type

Skin 206 499

Lymph 113 72

Other 103 158

Lymph + Skin 12

Lymph + Other 13

Skin + Other 26

Lymph + Skin + Other 2

Type Not Reported 48 39

”Other” includes: prostate (11), adenocarcinoma (7), lung (5), bladder (4), breast (2), cervix (2), colon (2), head/neck/throat (2), renal (2).


Freedom from MalignancyFor Adult Heart Recipients (Follow-ups: April 1994-June 2002)

0

10

20

30

40

50

60

70

80

90

100

0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5

Years

% F

ree

fro

m M

alig

nan

cy

All malignancy Lymph Skin Other


ADULT HEART TRANSPLANTS (4/1994-6/1997) Risk Factors for Developing CAV within 5 Years


95% Confidence

Interval

Diagnosis: Coronary Artery Disease 1.17 0.05 1.00 - 1.38

PRA > 20% 1.74 0.0009 1.25 - 2.42

Donor history of hypertension 1.30 0.04 1.01 - 1.66

Female donor 0.83 0.03 0.70 - 0.98

(N=4,797)




Donor age


Donor BMI/Recipient BMI



Recipient Age

0

0.5

1

1.5

2

20 25 30 35 40 45 50 55 60 65

Recipient Age

Od

ds

of

CA

V w

ith

in 5

Yea

rs

p = 0.006



Donor Age

0

0.5

1

1.5

2

10 15 20 25 30 35 40 45 50 55 60

Donor Age

Od

ds

of

CA

V w

ith

in 5

Yea

rs

p < 0.0001




0

0.5

1

1.5

2

0.6 0.8 1 1.2 1.4 1.6 1.8


Od

ds

of

CA

V w

ith

in 5

Yea

rs

p = 0.09



Center volume

0

0.5

1

1.5

2

0 10 20 30 40 50 60 70


Od

ds

of

CA

V w

ith

in 5

Yea

rs

p = 0.02


ADULT HEART TRANSPLANTS (4/1994-6/1997) Risk Factors for Developing CAV between 5 and 7 Years


95% Confidence

Interval Hospitalized for rejection within 5 years of transplant

1.93 0.005 1.23 - 3.05

Donor history of hypertension 2.23 0.01 1.19 - 4.17

(N=839)


ADULT HEART TRANSPLANTS (4/1994-6/1997) Risk Factors for Developing CAV between 5 and 7 Years

Donor BMI

0

0.5

1

1.5

2

2.5

3

17 19 21 23 25 27 29 31 33

Donor BMI (kg/m2)

Od

ds

of

CA

V w

ith

in 5

Yea

rs

p = 0.03


ADULT HEART TRANSPLANTS (1/1995-6/1997) Risk Factors for Developing Malignancy within 5 Years


95% Confidence

Interval

MMF at discharge 0.57 0.0004 0.42 - 0.78

Tacrolimus at discharge 0.48 0.007 0.29 - 0.82

Diagnosis: Coronary artery disease 1.29 0.01 1.06 - 1.56

Malignancy prior to transplant 1.93 0.006 1.20 - 3.11

Female 0.7 0.008 0.54 - 0.91

(N=4,371)



Continuous Factors (see figures)

Recipient age Donor BMI



Recipient Age

0

1

2

3

4

20 25 30 35 40 45 50 55 60 65

Recipient Age

Od

ds

of

Mal

ign

ancy

wit

hin

5 Y

ears

p < 0.0001



Donor BMI

0

0.5

1

1.5

2

17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32

Donor BMI (kg/m2)

Od

ds

of

Mal

ign

ancy

wit

hin

5 Y

ears

p = 0.007


ADULT HEART TRANSPLANT RECIPIENTS: Cause of Death (Deaths: January 1992 - June 2002)

CAUSE OF DEATH 0-30 Days (N = 2,454)

31 Days - 1 Year (N = 2,155)

>1 Year - 3 Years (N = 1,642)

>3 Years - 5 Years (N = 1,391)

>5 Years (N = 3,454)

CAV 44 (1.8%) 108 (5.0%) 243 (14.8%) 251 (18.0%) 588 (17.0%)

ACUTE REJECTION 157 (6.4%) 264 (12.3%) 156 (9.5%) 60 (4.3%) 39 (1.1%)

LYMPHOMA 1 (0.0%) 44 (2.0%) 78 (4.8%) 79 (5.7%) 181 (5.2%)

MALIGNANCY, OTHER 2 (0.1%) 49 (2.3%) 171 (10.4%) 269 (19.3%) 661 (19.1%)

CMV 3 (0.1%) 27 (1.3%) 14 (0.9%) 3 (0.2%) 4 (0.1%)

INFECTION, NON-CMV 348 (14.2%) 745 (34.6%) 216 (13.2%) 138 (9.9%) 333 (9.6%)

PRIMARY FAILURE 602 (24.5%) 183 (8.5%) 118 (7.2%) 67 (4.8%) 191 (5.5%)

GRAFT FAILURE 403 (16.4%) 226 (10.5%) 282 (17.2%) 201 (14.5%) 466 (13.5%)

TECHNICAL 183 (7.5%) 24 (1.1%) 15 (0.9%) 17 (1.2%) 36 (1.0%)

OTHER 83 (3.4%) 103 (4.8%) 114 (6.9%) 97 (7.0%) 205 (5.9%)

MULTIPLE ORGAN FAILURE

342 (13.9%) 204 (9.5%) 80 (4.9%) 73 (5.2%) 270 (7.8%)

RENAL FAILURE 14 (0.6%) 16 (0.7%) 27 (1.6%) 44 (3.2%) 203 (5.9%)

PULMONARY 109 (4.4%) 71 (3.3%) 72 (4.4%) 51 (3.7%) 128 (3.7%)

CEREBROVASCULAR 163 (6.6%) 91 (4.2%) 56 (3.4%) 41 (2.9%) 149 (4.3%)

2003 ishlt j heart lung transplant 2003; 22: 610-72. heart transplantation overall

Documents

ishlt j heart lung transplant

adult heart transplants

number of heart transplants

adult heart retransplants

year of transplant slide

year slide

transplantation slide

year mortality slide